What is Breast Implants?

Breast implant surgery also called breast augmentation or enlargement is the most common type of cosmetic surgery carried out in the UK.

It’s estimated more than 30,000 such procedures are carried out in the UK every year. Most of these are carried out privately, with fewer than 4,500 operations to fit breast implants carried out on the NHS during 2012-13.

How the Breast Implant Procedure is Done

Because breasts can continue to develop until a woman reaches her late teens or early 20s, the FDA requires that women be at least 18 years old to get breast augmentation with saline-filled implants and at least 22 years old to receive silicone implants.

When picking your surgeon, look for one who has a lot of experience. You may be less likely to have complications later on if you choose a surgeon who has had at least five years of surgical training and at least two years’ experience in plastic surgery.

Before your breast implant procedure, you will meet with your surgeon for a medical evaluation. You can talk about what you want and get feedback from the doctor. Your surgeon may ask you to stop taking certain medications a few days or weeks before your surgery.

You can get breast augmentation done as an outpatient procedure, or you may stay overnight in the hospital.

The procedure takes one to two hours. You will likely be given general anesthesia, during which you will be “asleep” and pain-free.

The surgeon will make a cut under your breasts, under your arms, or around your nipples, depending on your body, the type of implant, and how much enlargement is being done.

The surgeon will put the breast implant into a pocket above or below your chest muscle. After the implant is in place, the surgeon will close the cuts with sutures or surgical tape.

Types of breast implants

Breast implants are artificial (prosthetic) implants. In the UK, two types of breast implants are commonly used:

Saline breast implants

Saline implants are filled with sterile salt water. They’re inserted empty, and then filled once they’re in place.

Saline breast implants are available to women 18 and older for breast augmentation and to women of any age for breast reconstruction.

Silicone breast implants

Silicone implants are pre-filled with silicone gel a thick, sticky fluid that closely mimics the feel of human fat. Most women feel that silicone breast implants look and feel more like natural breast tissue.

Silicone breast implants are available to women 22 and older for breast augmentation and to women of any age for breast reconstruction.

What are the risks of breast implants?

Saline and silicone breast implants pose similar risks, including:

Scar tissue that distorts the shape of the breast implant (capsular contracture)

Breast pain

Infection

Changes in nipple and breast sensation, usually temporary

Implant leakage or rupture

Correcting any of these complications might require additional surgery, either to remove or replace the implants.

Removal of breast implants

Removal of the implant(s), with or without replacement, is one type of reoperation. As many as 20 percent of women who receive breast implants for augmentation have to have their implants removed within 8 to 10 years. You may need to have your implant removed at some time over the course of your life because of one or more local complications.

After removal, some women do not choose to replace their implants. These women may have cosmetically undesirable dimpling, puckering, or sagging of their natural breasts.

The photograph below shows a 29-year-old woman 1 year after having her silicone gel-filled breast implants removed, but not replaced. Women with large breast implants, especially those inserted under and within the breast glands but not on top of the chest muscles (subglandularly), may have major cosmetic deformity if they choose not to replace them or to undergo additional reconstructive surgery.

Some insurance companies do not cover implant removal or implant replacement, even if the first implant surgery was covered.

Capsular Contracture

Capsular contracture is the hardening of the breast around the implant. It can occur in the tissue surrounding one or both implants. This hardening causes the tissue to tighten, which can be painful.

Capsular contracture may be more common following infection, hematoma and seroma. However, the cause of capsular contracture is not known.

There are four grades of capsular contracture, known as Baker grades.

Baker Grading Scale

Grade I: Breast is normally soft and looks natural

Grade II: Breast is a little firm but looks normal

Grade III: Breast is firm and looks abnormal

Grade IV: Breast is hard, painful, and looks abnormal

Grades III and IV capsular contracture are considered severe, and may require reoperation. The surgical procedure usually involves removal of the implant with or without replacement of the implant. There is a possibility that capsular contracture could occur again after surgery to correct it.

The picture below shows a Grade IV capsular contracture in the right breast of a 29-year- old woman 7 years after placement of silicone gel-filled breast implants.

Rupture and Deflation in Saline-Filled Breast Implants

The term rupture is used for all types of breast implants, but the term deflation is only used for saline-filled implants. You and/or your doctor will be able to tell if your saline-filled implant ruptures because the saline solution leaks into your body immediately or over several days. You will notice that your implant loses its original size or shape.

The following surgical procedures are not recommended for FDA-approved saline-filled breast implants because they are known to cause rupture and deflation:

Closed capsulotomy – a technique used to relieve capsular contracture involving manually squeezing the breast to break the hard capsule

Placement of drugs or other substances inside the implant other than sterile saline

Any contact of the implant with Betadine, a povidone-iodine topical antiseptic made by Purdue Frederick Company

Injection through the implant shell

Alteration of the implant

Stacking of the implants (more than one implant per breast pocket).

The photograph below shows a 30-year-old woman whose left saline-filled breast implant deflated. The implant is thought to have deflated due to a particular design, which is no longer used by the manufacturer.

Deciding to have breast implants

The decision to have breast implants should be an informed one that takes into account the potential health risks and financial costs.

If you are considering having breast implants, it’s a good idea to speak to your GP and a cosmetic surgeon beforehand about why you want them, your expectations of surgery, the procedure itself, and the potential risks.

Take your time to find out as much as you can beforehand, and don’t feel rushed or pressured into making a decision.

Possible Complications

Although it is a cosmetic procedure, breast implant surgery can have risks, such as:

Breast pain

Changes in sensation in the nipple and breast

Scar tissue forming and hardening in the area around the implant

Scarring

Bleeding

Infection

Problems with the size or shape of the implants (for example, the breasts may not be symmetrical)

It is also possible for implants to rupture and leak. If saline implants rupture, the saline will be safely absorbed by the body. A silicone leak may stay inside the implant shell or leak outside of the shell. When a saline implant ruptures, it will deflate. But silicone breast implants may cause no obvious symptoms when they rupture. This is called silent rupture.